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Community Health Officers Extend Primary Health Care in Ghana

In the 1990s the Navrongo research center started the
Community-based Health Planning and Services (CHPS) initiative 3 pilot
districts. The CHPS Initiative has now become the national strategy for
implementing community-based service delivery by reorienting and relocating
primary health care from sub-district health centers to convenient community
locations.[1]
CHPS is even seen as crucial to Ghana’s broader poverty reduction agenda and
policy.

CHPS Compound, Upper East region

CHPS Compound, Western region

The CHPS Operational Policy notes that, CHPS was designed to
operate at the third tier of the district health system that encompassed a
district hospital, sub-district health centers and community-based services by addressing
the needs of zones of 3000-4,500 residents “where primary health care
services will be provided to the population by a resident Community Health
Officer (CHO) assisted by the Community structures and volunteer systems. The
deployment of all elements necessary for the CHO to provide house-to house
service shall make that zone a fully functional CHPS zone within the
sub-district,” thus creating CHPS compounds. It is the CHO who represents
the human resource innovation in the Ghana system

A CHO engages each Community within the zone in micro
planning of health activities termed “community decision making systems,”
building on the following key elements: Community (as social capital); Households
and individuals (as target); Planning with the community (community
participation); and Service delivery with the community (client focused).

Community health nurses (CHN) trained in the nation’s
various schools of nursing would be designated a CHO once they were posted to a
CHPS compound. The CHPS compound, often a building donated by the community or
a philanthropist served as a health post and accommodation for the CHO. There
could be two CHOs and a trained midwife, since CHNs are not trained to conduct
delivery. The CHOs are expected to deliver a package of essential primary
health care and promotion services at the community level that revolves around
home visiting. The idea is to take services to the clients.

While the curriculum of a CHN addresses some basic issues of
the CHPS program, CHNs do not exit school as ready-made CHOs. Those who opt to
become CHOs must receive orientation from the regions and districts where they
work in a CSPS. Depth and quality of orientation varies. CHOs could be assisted
by community health volunteers who are supervised by a community health
committee.

Sacks et al.
report that CHNs obtain a Certificate in Community Health Nursing as part of
pre-service training after completing a 2-year curriculum post-secondary
school.[2]
After 3-5 years of service, CHNs can enroll for higher education to become a
midwife or public health nurse (PHN). Sacks and colleagues found that CHN/CHO
satisfaction was often determined by professional isolation and lack of basic
resources and materials to perform their jobs.

By 2002, 95 out of 110 districts had launched the CHPS
program, though not every potential zone was covered. The rapid national
expansion of the CHPS program may have contributed to some of the CHNs’
frustrations, as the time was not taken to recruit and train health workers
from the target communities who would have spoken the same language. Facilities
were not upgraded prior to the increase of health workers and communities were
not prepared to provide free housing to CHNs, as originally planned, say Sacks
and co-researchers. Although the original goal was for CHPS to achieve complete
national coverage by 2015 through the establishment of 6,000 CHPS zones,
challenges led to completion of only 3,000 CHPS zones by then. Now, more than 20 years after the initial
trial, Ghana is re-launching the CHPS policy to elevate PHC as a priority and to
expand the CHPS model to parts of the country that are not yet covered.[3]

The three broad areas of work by the CHO include basic primary
health care issues such as promotion and prevention, management of minor or
common ailment and their referrals and case detection, mobilization and
referrals. Ghana Web reports that,[4]
CHPS compounds cover all 8 essential PHC services and aim at helping ensure
improved access to primary health care in these communities. For proper
functioning of the various CHPS compounds, there is very strong community
participation in the implementation.

The article reports that, “Where there is strong community
participation, traditional leaders and community members provide resources,
both financial and non-financial incentives, to support implementation of the
program. A CHO is expected to work in partnership with the community,
households and district assemblies to ensure that, citizens are able to access
services and health information as and when they need them whereas the
communities are expected to also exert some levels of answerability to health
providers.”

The Upper West Region serves as an example of CHPS and CHOs implementation
as reported by the Ghana News Agency.[5]
There are 308 functional CPHS zones out of 361 planned which cover 62% of the
population. The region had 364 CHOs in the 308 functioning zones and 305 active
community committees, with 1,669 volunteers. Unfortunately, only 155 of the
functioning CHPS zones were fully equipped to standard. A relaunch of CHPS will
focus on performance guidelines, systems strengthening and quality of services

[3]
John Koku Awoonor-Williams, Elisabeth Tadiri, and Hannah Ratcliffe .
Translating research into practice to ensure community engagement for
successful primary health care service delivery: The case of CHPS in Ghana.
https://improvingphc.org/translating-research-practice-ensure-community-engagement-successful-primary-health-care-service-delivery-case-chps-ghana

https://t.co/yKKsmAEpSv @MinSanteRDC #Ebola 23 May 2019: Since beginning of epidemic, cumulative number of cases is 1,888, of which 1,800 confirmed 88 are probable. In total, there were 1,254 deaths (1,166 confirmed and 88 probable) and 492 people cured. 11 new confirmed cases